Artículos (Medicina)

URI permanente para esta colecciónhttps://hdl.handle.net/11441/11045

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Progression towards microelimination of hepatitis B virus infection among people living with HIV in Spain
(Ediciones Doyma S A; Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, 2025) Santos, Marta; Martín Carmona, Jesica; Corma-Gómez, Anais; Pérez-García, Margarita; Martín-Sierra, Carmen; Rincón-Mayo, Pilar; Pineda Vergara, Juan Antonio; Real Navarrete, Luis Miguel; Macías Sánchez, Juan; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Bioquímica Médica y Biología Molecular e Inmunología; Instituto de Biomedicina de Sevilla (IBIS)
Introduction The WHO proposed to achieve hepatitis B virus (HBV) elimination by 2030, but this goal is very difficult to attain. People living with HIV (PLWH) may represent a subset where microelimination can be reached sooner. This study aimed to assess the incidence of HBV infections and changes in the prevalence of active HBV infection among PLWH in Spain. Methods A prospective cohort study, including all PLWH attending a university hospital in Southern Spain from January 2011 to December 2022, was conducted. Serum HBV markers (HBsAg, anti-HBs, anti-HBc) were tested at baseline and at least yearly afterwards. Incident cases were identified by anti-HBc seroconversion. Results Nine hundred and eighty PLWH were included. At the beginning of the study, 26 (2.7% [95% CI: 1.7–3.8%]) tested positive for HBsAg, 428 (43.7% [95% CI: 42.8–49.4%]) for anti-HBc and 386 (39.4% [95% CI: 39.8–46.3%]) for anti-HBs. After a median (Q1–Q3) follow-up of 115 (35–143) months, two new infections were documented, yielding an incidence rate of 2.24 (95% CI: 0.27–8.1)/100,000 person-years. The prevalence of active HBV infection declined from 3.4% [95% CI: 2.0–5.0%] in 2011 to 2% [95% CI: 1.0–3.0%] in 2022 (p for linear trend = 0.027). At the end of the study, 167 (24%) PLWH still were susceptible to HBV. Conclusions The incidence of HBV infection among PLWH in Spain is close to the WHO target. The prevalence of active HBV infection has decreased substantially during the last 12 years. These data suggest that micro-elimination of HBV/HIV infection is on the track in Spain.
Incidence and Predictors of Worsening Renal Function in Edoxaban-Treated Atrial Fibrillation Patients Within ETNA-AF-Europe Registry
(JACC Journals, 2024-04-03) Gwechenberger, Marianne; Barón-Esquivias, Gonzalo; Vries, Tim A.C. de; Siller-Matula, Jolanta M.; Manu, Marius C.; Souza, José A.G.; Wienerroither, Sebastian; Pecen, Ladislav; Groot, Joris R. de; Caterina, Raffaele de; Kirchhof, Paulus; Universidad de Sevilla. Departamento de Medicina
BACKGROUND Managing patients with atrial fibrillation (AF) and worsening renal function (WRF) remains a clinical challenge due to the need of dose adjustment of non-vitamin K antagonist oral anticoagulants. OBJECTIVES To determine the incidence of WRF in patients with AF treated with edoxaban, the association of WRF with clinical outcomes, and predictors of WRF and clinical outcomes in these patients. METHODS This is a subanalysis of the Edoxaban Treatment in routiNe clinical prActice for patients with non-valvular Atrial Fibrillation in Europe study (NCT02944019), an observational study of edoxaban-treated patients with AF. WRF was defined as a $25% reduction in creatinine clearance between baseline and 2 years. RESULTS Of the 9,054 patients included (69% of the total 13,133 enrolled), most did not experience WRF (90.3%) during the first 2 years of follow-up. WRF occurred in 9.7% of patients. Patients with WRF had significantly higher rates of all-cause death (3.88%/y vs 1.88%/y; P < 0.0001), cardiovascular death (2.09%/y vs 0.92%/y; P < 0.0001), and major bleeding (1.51%/y vs 0.98%/y; P ¼ 0.0463) compared with those without WRF. Rates of intracranial hemorrhage (0.18%/y vs 0.18%/y) and of any stroke/systemic embolic events were low (0.90%/y vs 0.69%/y; P ¼ 0.3161) in both subgroups. The strongest predictors of WRF were a high CHA2DS2-VASc score, high baseline creatinine clearance, low body weight, and older age. Most predictors of WRF were also predictors of clinical outcomes. CONCLUSIONS WRF occurred in approximately 10% of edoxaban-treated AF patients. Rates of death and major bleeding were significantly higher in patients with WRF than without. Stroke events were low in both subgroups. (JACC Adv 2024;3:100880) © 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management
(European Society of Clinical Microbiology and Infectious Diseases, 2010-12) Rodríguez, D.; Pigrau, Carles; Euba, G.; Cobo, Javier; García-Lechuz, J.; Palomino, Javier; Riera, Montse; Toro López, María Dolores del; Granados, Ana; Ariza, X.; REIPI Group (Spanish Network for Research in Infectious Disease); García Cabrera, Emilio; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS); Ministerio de Sanidad y Consumo. España; Instituto de Salud Carlos III
The optimum treatment for prosthetic joint infections has not been clearly defined. We report our experience of the management of acute haematogenous prosthetic joint infection (AHPJI) in patients during a 3-year prospective study in nine Spanish hospitals. Fifty patients, of whom 30 (60%) were female, with a median age of 76 years, were diagnosed with AHPJI. The median infection-free period following joint replacement was 4.9 years. Symptoms were acute in all cases. A distant previous infection and/or bacteraemia were identified in 48%. The aetiology was as follows: Staphylococcus aureus, 19; Streptococcus spp., 14; Gram-negative bacilli, 12; anaerobes, two; and mixed infections, three. Thirty-four (68%) patients were treated with a conservative surgical approach (CSA) with implant retention, and 16 had prosthesis removal. At 2-year follow-up, 24 (48%) were cured, seven (14%) had relapsed, seven (14%) had died, five (10%) had persistent infection, five had re-infection, and two had an unknown evolution. Overall, the treatment failure rates were 57.8% in staphylococcal infections and 14.3% in streptococcal infections. There were no failures in patients with Gram-negative bacillary. By multivariate analysis, CSA was the only factor independently associated with treatment failure (OR 11.6; 95% CI 1.29–104.8). We were unable to identify any factors predicting treatment failure in CSA patients, although a Gram-negative bacillary aetiology was a protective factor. These data suggest that although conservative surgery was the only factor independently associated with treatment failure, it could be the first therapeutic choice for the management of Gram-negative bacillary and streptococcal AHPJI, and for some cases with acute S. aureus infections.
FibroScan-AST Score vs Liver Stiffness for the Prediction of Liver Events After HCV Cure
(Oxford Univ Press, 2025-04-08) Corma-Gómez, A.; Corona-Mata, D; Martín-Carmona, Jésica; Galindo, MJ; Camacho, A; Martín-Sierra, C; Pineda Vergara, Juan Antonio; Real Navarrete, Luis Miguel; Macías Sánchez, Juan; GEHEP-011 Study Grp; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Bioquímica Médica y Biología Molecular e Inmunología; Instituto de Biomedicina de Sevilla (IBIS); Instituto de Salud Carlos III
Background Liver stiffness (LS) predicts liver complication occurrence in patients with hepatitis C virus (HCV) infection after sustained virological response (SVR). The FibroScan-AST (FAST) score, which includes aspartate aminotransferase (AST) and controlled attenuation parameter (CAP; measured by FibroScan), may improve the prediction ability of isolated LS. Our aim was to compare the predictive capacity of LS vs FAST in this setting. Methods Multicenter cohort study including individuals with HIV/HCV coinfection or HCV monoinfection from Spain if they had (1) LS ≥9.5 kPa pretreatment, (2) SVR with a direct-acting antiviral (DAA)–based regimen, and (3) LS and CAP measurement at SVR. Fatty liver disease (FLD) was defined as CAP ≥248 dB/m. The primary outcome was the occurrence of a liver complication (decompensation or hepatocellular carcinoma [HCC]) after SVR. Results Three hundred patients were included; 213 (71%) had HIV. At SVR, 131 (44%) had FLD. The FAST score was <0.35 in 182 (61%), 0.35–0.67 in 79 (27%), and >0.67 in 34 (12%) patients. After a median (Q1–Q3) follow-up of 73 (53–83) months, 36 (12%) liver complications (15 [5%] HCC) occurred. LS was independently associated with an increased risk of developing liver complications (sub–hazard ratio [sHR], 1.06; 95% CI, 1.04–1.08; P < .001). In a separate model, FAST ≥0.35 was also independently associated with greater risk of liver complications (sHR, 8.12; 95% CI, 3.11–21.17; P < .001). The area under the receiver operating characteristics curve of the model based on LS was 0.83 (95% CI, 0.76–0.91), and that of the model based on FAST was 0.80 (95% CI, 0.72–0.88; P = .158). Conclusions The FAST score predicts the development of liver events after SVR but does not improve the predictive capacity of LS alone at this time point.
Situación de la docencia universitaria en neumología y cirugía torácica en España
(Universidad de Sevilla, 2024-12-20) López-Campos Bodineau, José Luis; Caballero Eraso, Candelaria; Quintana-Gallego, Esther; Universidad de Sevilla. Departamento de Medicina
Objetivos. La organización y la coordinación de la información que se imparte a los alumnos de medicina resulta esencial para una formación docente adecuada. El objetivo del presente proyecto fue revisar la organización de las asignaturas que imparten neumología y cirugía torácica en el grado de medicina en todas las universidades españolas. Método. Para obtener la información de análisis, accedimos al listado de grados de medicina disponibles en España a través del registro de universidades, centros y títulos disponible en el Ministerio de Ciencia, Innovación y Universidades en enero 2024. Posteriormente buscamos en las webs de las universidades los programas de las asignaturas que impartían neumología o cirugía torácica. De cada web y programa docentes seleccionamos la información sobre las universidades, la organización de las asignaturas, el profesorado y los contenidos docentes de las clases teóricas. Resultados. En el momento del análisis existían en España 50 universidades (11 privadas) con grado en medicina, de las que obtuvimos el programa completo en 45 universidades. La mayoría eran asignaturas semestrales que se impartían en 4º año del grado. Las asignaturas eran médico-quirúrgicas en 40 casos y 31 asignaturas estaban dedicadas en exclusividad a respiratorio. Las horas docentes presentaban una variabilidad considerable entre 12 y 47 horas. El 62,3% de los profesores eran miembros de la Sociedad Española de Neumología y Cirugía Torácica. Los temas impartidos presentaban una considerable variabilidad. Conclusiones. Nuestros datos resumen la situación de la docencia universitaria en neumología y cirugía torácica en España mostrando con una considerable variabilidad tanto en la organización de las asignaturas, como el profesorado y en los contenidos de las asignaturas.
Tratamiento de las alopecias de patrón masculino y femenino. Eficacia clínica del aminexil y SP94 en dos series de 180 pacientes, hombres y mujeres
(Medigraphic, 2013) Camacho Martínez, Francisco Miguel; Camacho Serrano, Francisco; Moreno Giménez, José Carlos; García Hernández, María José; Polo Padillo, Juan; Perea Cejudo, Manuel; Coronel Pérez, María Isabel; Universidad de Sevilla. Departamento de Medicina
El efecto del aminexil combinado con SP.94 fue evaluado como positivo en un grupo de pacientes de ambos sexos. Para poder confirmar estos positivos efectos se ha realizado un estudio en 180 pacientes de cada sexo en las Unidades de Tricología de dos Hospitales. Los pacientes se aplicaron sobre cuero cabelludo y cabellos húmedos 6 ml. de la loción todas las noches. A los pacientes se les realizó controles al comienzo del tratamiento y a los 45, 90 y 180 días. Se efectuó en todos tipificación de la alopecia según las escalas de Ebling y Ludwig, y se les preguntó por su edad separandolos en grupos de menores de 17 años, entre 18 y 34 años, entre 35 y 49 años, y 50 o más años. También se interrogó por enfermedades y medicación concomitantes, presencia de dermatitis seborreica, cantidad de cabellos caídos en un lavado de 48 horas antes, deficiencias nutricionales o errores congénitos. A las mujeres con signos clínicos de síndrome SAHA se les realizó una analítica hormonal. La exploración del paciente en cada visita incluyó la realización de un tricograma con estudio del diámetro de los cabellos, signo de arrancamiento, sebometrías, corneometría, control iconográfico, graduación de la alopecia, y una valoración de la evolución de la dermatitis seborreica según una escala cuantitativa. En las visitas también se les pidió a los pacientes una valoración de la cosmeticidad y eficacia del producto, que de un modo subjetivo se dividió en peor, igual, aceptable-mejor o excelente, que contrastamos con dos médicos que hicieron una evaluación externa basándose en los datos aportados en las visitas y en las iconografías. Se valoró el cumplimiento del paciente mediante el cuestionario de Morisky-Green. Los pacientes que no cumplieron el protocolo de aplicación o que no vinieron a alguna de las visitas fueron sustituidos. Los resultados permiten asegurar que aminexil asociado a SP94 detiene o retrasa la caída del cabello y favorece su engrosamiento, aunque no hemos comprobado que provoque un recrecimiento importante de nuevos cabellos ya perdidos por el proceso evolutivo de la alopecia androgenética, ni que actúa sobre la seborrea y ni dermatitis seborreica.
Innovar investigando durante el Grado de Medicina. El papel del mentor de investigación
(2023-12-01) Cordero Matia, María Elisa; Universidad de Sevilla. Departamento de Medicina
La participación en investigación durante el Grado de Medicina está vinculada al desarrollo de una carrera investigadora en el postgrado, con un aumento significativo en publicaciones científicas y mejora en la proyección profesional. Incluso para aquellos estudiantes que no buscan una carrera investigadora, la investigación durante el grado aporta habilidades transferibles a la práctica clínica que mejorarán su actividad asistencial como médicos. A pesar de las ventajas claras, la implicación de los estudiantes de Medicina es escasa. En esta revisión se analizarán diferentes medidas de innovación a aplicar durante los estudios de Grado que faciliten la incorporación de la investigación al currículo del alumno, analizando especialmente el papel del mentor de investigación.
Implementación de modelos de ChatGPT personalizados para el aprendizaje basado en problemas y educación inversa en estudiantes de medicina
(Universidad de Sevilla, 2025-03-21) Grilo Bensusan, Israel; Universidad de Sevilla. Departamento de Medicina
La enseñanza tradicional de la medicina ha estado dominada por la clase magistral, un modelo efectivo pero limitado en su capacidad de involucrar activamente a los estudiantes. Con la evolución tecnológica, métodos innovadores como la educación inversa y el aprendizaje basado en problemas están transformando este paradigma. En la educación inversa, los estudiantes acceden previamente a contenidos teóricos mediante videos, presentaciones y materiales complementarios, facilitando el uso de sesiones presenciales para resolver dudas y aplicar conocimientos, un enfoque que promueve el aprendizaje activo y significativo. Una de las principales innovaciones presentadas es el uso de inteligencia artificial, específicamente ChatGPT, para crear pacientes virtuales personalizados. Estos modelos simulan casos clínicos realistas, respondiendo preguntas en tiempo real, proporcionando resultados de pruebas complementarias y fomentando el desarrollo de competencias prácticas. La integración de estos pacientes virtuales en clases presenciales permitió a los estudiantes practicar habilidades clínicas esenciales, como la anamnesis y la estructuración de historias clínicas, bajo la supervisión del docente. A pesar de los desafíos iniciales, como la baja visualización de materiales previos y la carencia de imágenes diagnósticas avanzadas, este modelo demuestra ser una herramienta poderosa para conectar teoría y práctica, transformando la formación médica y preparando a los futuros médicos para enfrentar retos clínicos reales.
La ecografía virtual en la formación en el grado en Medicina
(Universidad de Sevilla, 2023-05-10) Calderón Sandubete, Enrique José; Universidad de Sevilla. Departamento de Medicina
El Hospital simulado en la educación médica: retos económicos, beneficios docentes y claves para la sostenibilidad
(Universidad de Sevilla, 2025-03-19) Capitan-Morales, Luis-Cristobal; Capitán Pacheco, Amelia; Calderón Sandubete, Enrique José; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina
Clinical Characteristics, Diagnostic Approaches, Therapeutic Management, and Associated Comorbidities of Prurigo Nodularis (Chronic Nodular Prurigo): An Observational Study in Clinical Practice in Spain
(Wiley, 2025-06-01) Armario‐Hita, José Carlos; Pereyra-Rodríguez, José-Juan; de Ortiz de Frutos, Francisco Javier; Herranz, Pedro; Silvestre‐Salvador, Juan Francisco; Rodríguez Serna, Mercedes; Serra, Esther; Ruiz‐Villaverde, Ricardo; Universidad de Sevilla. Departamento de Medicina
Background: Prurigo nodularis/chronic nodular prurigo (PN/CNP) is a subtype of chronic prurigo characterized by pruritic nodules on the limbs and trunk. It predominantly affects older adults and women. The multifactorial etiology of PN/CNP complicates its diagnosis and treatment. This study aims to evaluate the clinical characteristics, diagnostic approaches, and patient burden of PN/CNP in Spain. Methods: This observational, cross-sectional, multicenter study was conducted across 12 Spanish hospitals and involved adult patients with PN/CNP. Data were collected from clinical records, patient interviews, and self-administered questionnaires. The study assessed clinical characteristics, diagnostic methods, treatments, and the burden of the disease. Descriptive statistics were used for analysis. Results: A total of 97 patients with PN/CNP were included, 65% of whom were female. The cohort had a mean age of 53 years. Most patients were White (87.5%) with Fitzpatrick phototype III (60.9%). Common comorbidities included dyslipidemia (36.1%), atopic dermatitis (33%), and anxiety/depression (30.9%). Topical treatments were used by 67% of patients, while systemic treatments were used by 63.9%. The average time to diagnosis was 4.5 years, and most patients reported mild to moderate pruritus and pain. Key therapeutic goals included reducing itch intensity (76.3%) and lesion count (37.1%). Overall, 66% of patients were satisfied with their treatment. Conclusion: This study provides a comprehensive profile of patients with PN/CNP in Spain, highlighting complex clinical characteristics and diverse treatment patterns. The findings emphasize the need for innovative, multidisciplinary approaches to the management of PN/CNP to improve patient care and guide future research.
Decreased number of myeloid-derived suppressor cells in the placental trophoblast of gestational diabetes mellitus. Possible role of leptin
(Elsevier, 2025-03-25) Tami, Malika; Hontecillas-Prieto, Lourdes; García-Domínguez, Daniel J.; Flores-Campos, Rocío; Vilariño-García, Teresa; Sanchez Jimenez , Flora; Guadix, Pilar; Dueñas Díez, José Luis; Jimenez Cortegana, Carlos; Cruz Merino, Luis de la; Pérez Pérez, Antonio; Sánchez Margalet, Víctor; Universidad de Sevilla. Departamento de Bioquímica Médica y Biología Molecular e Inmunología; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina; Instituto de Biomedicina de Sevilla (IBIS); FEDER Funds; Instituto de Salud Carlos III (ISCIII); Universidad de Sevilla. CTS607: Salud Reproductiva de la Mujer; Universidad de Sevilla. CTS151: Bioquímica Medica
Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and significantly increases both maternal and fetal morbidity and mortality. Inflammation is a hallmark of GDM, and placental inflammation may play a key role in the pathophysiology of the disease. Myeloid-derived suppressor cells (MDSCs), which are innate immunosuppressive, are thought to contribute to feto-maternal tolerance. In normal pregnancies, elevated levels of MDSCs have been observed in both peripheral and umbilical cord blood. Our hypothesis postulates that trophoblasts from placentas belonging to women with GDM may have lower levels of MDSCs compared to trophoblasts from placentas originating from healthy pregnancies. Furthermore, since leptin is overexpressed in the placenta of GDM patients, we hypothesized that leptin might contribute to the reduction of MDSCs. To test this, we investigated the in vitro effects of leptin on MDSC levels in isolated peripheral blood leukocytes after 24 h of incubation. Our findings indicate that trophoblasts from placentas from women with GDM contain a lower percentage of MDSCs compared to trophoblasts from healthy pregnancies. In addition, in vitro studies demonstrated that leptin reduces the number of MDSCs in peripheral blood leukocytes. In conclusion, MDSCs are decreased in placentas from pregnancies with GDM, and leptin appears to reduce the number of MDSCs in leukocytes isolated in vitro. Increased leptin expression in trophoblasts from placentas of women with GDM may contribute to the lower levels of MDSCs, potentially playing a role in placental inflammation. However, further investigations are required to fully elucidate this mechanism.
Safety and efficacy of immunoguided prophylaxis for cytomegalovirus disease in low-risk lung transplant recipients in Spain: a multicentre, open-label, randomised, phase 3, noninferiority trial
(Elsevier, 2025-03-26) Páez Vega, Aurora; Vaquero Barrios, José M.; Ruiz Arabi, Elisa; Iturbe Fernández, David; Alonso, Rodrigo; Ussetti Gil, Piedad; Lobo Acosta, María Ángeles; Gutiérrez Gutiérrez, Belén; Torre Cisneros, Julián; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red (CIBER); European Union (UE); Gobierno de España; Sociedad Andaluza de Trasplante de Órganos y Tejidos (SATOT)
Background: The standard prophylaxis treatment for cytomegalovirus (CMV) disease in CMV-seropositive lung transplant recipients is six months of prophylaxis with valganciclovir followed by six months of pre-emptive therapy. This protocol is associated with adverse events and risk of resistance. We have previously shown that prophylaxis can be suspended in CMV-seropositive kidney transplant recipients receiving thymoglobulin without increasing the risk of CMV disease and reducing the incidence of neutropenia. The objective of the current study is to demonstrate that immunoguided prophylaxis is effective and safe in seropositive lung transplant recipients. Methods: A phase III, multicentre, randomised, open-label, noninferiority clinical trial was conducted in adult lung transplant recipients. Patients were randomised (1:1) to two groups: (1) immunoguided prophylaxis (IP), consisting of 3 months of universal prophylaxis followed by CMV-specific cell-mediated immunity-guided discontinuation, or (2) standard prophylaxis (SP), consisting of 6 months of prophylaxis followed by pre-emptive therapy, both for a total of 12 months. The noninferiority margin was 7%. The primary and secondary efficacy endpoints were CMV disease and asymptomatic CMV replication at month 18. The primary and secondary safety endpoints were incidence of neutropenia (defined as neutrophil count <1500 cells/μL), incidence of rejection and number of days of valganciclovir prophylaxis. This trial was registered in EudraCT (2018-003300-39) and ClinicalTrials.gov (NCT03699254). This trial has been completed. Findings: Patients were recruited between April 2019 and December 2021 in seven Spanish centres. A total of 150 patients were randomised (75 patients per group). Incidence of CMV disease at month 18 did not differ among groups (18·7% [14 patients] vs. 16·0% [12 patients]; risk difference [RD] −0·03 [95% CI −0·15% to 0·06%]; P = 0·620) but occurred earlier in the IP group compared to the SP group. The proportion of patients who developed CMV disease at ≤180 days after transplant was higher in the IP group compared with the SP group (8% [6 patients] vs. 0% [0 patients]; RD −0·08 [95% CI −0·14 to −0·02; P = 0·009]). Asymptomatic CMV replication was reduced in the IP group vs. the SP group (4·0% [3 patients] vs. 16·0% [12 patients]; adjusted RD 0·12 [95% CI 0·03–0·21; P = 0·009]). A total of 30 patients (40%) in the IP group did not require prophylaxis from month 4 to 12. No significant difference was observed in the proportion of patients with neutropenia during months 4 to 7 (14·7% [11 patients] vs. 25·3% [19 patients]; RD 0·11 [95% CI −0·02 to 0·23]; P = 0·090) or rejection (33·3% [25 patients] vs. 30·7% [23 patients]; RD −0·03 [95% CI −0·18 to 0·12; P = 0·690]). The median days of valganciclovir was lower in the IP group than in the SP group (137 [92–266] vs. 198 [173–281]; P < 0.001). Interpretation: Immunoguided prophylaxis was noninferior to the standard of care in preventing CMV disease in lung transplant recipients. It could be considered for implementing in clinical practice in CMV-seropositive lung transplant recipients upon considering the study limitations.
Erratum to: Effectiveness and Safety of CT-P13 (Biosimilar Infliximab) in Patients with Inflammatory Bowel Disease in Real Life at 6 Months
(Springer Nature, 2017-06-28) Argüelles Arias, Federico; Guerra Veloz, María Fernanda; Perea Amarillo, Raúl; Vilches Arenas, Ángel; Castro Laria, Luisa; Maldonado Pérez, Belén; Chaaro, D.; Merino Bohórquez, Vicente; Romero Gómez, Manuel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Farmacología; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria
Copyright modification of the article: "Effectiveness and safety of CT-P13 (infliximab biosimilar) in patients with inflammatory bowel disease in real-life settings at 6 months".
Effectiveness and Safety of CT-P13 (Biosimilar Infliximab) in Patients with Inflammatory Bowel Disease in Real Life at 6 Months
(Springer Nature, 2017-06-28) Argüelles Arias, Federico; Guerra Veloz, María Fernanda; Perea Amarillo, Raúl; Vilches Arenas, Ángel; Castro Laria, Luisa; Maldonado Pérez, Belén; Chaaro, D.; Merino Bohórquez, Vicente; Romero Gómez, Manuel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Farmacología; Instituto de Biomedicina de Sevilla (IBIS); Kern Pharma; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria
Background: CT-P13 is a biosimilar of Remicade©, an agent approved in some countries for use in inflammatory bowel disease (IBD). Controlled clinical trials have demonstrated the efficacy and safety of CT-P13 in rheumatic diseases, but not in IBD. Aims: To assess the effectiveness and safety of CT-P13 in IBD patients in real clinical practice. Methods: This is a prospective observational study in patients with moderate to severe Crohn’s disease or ulcerative colitis treated with CT-P13. The study was performed in one single center. Patients included were naive or switched to anti-TNF treatment from the reference infliximab (Remicade©) to CT-P13. Efficacy and safety were assessed in naive and switched patients who were in remission at the time of the switch at months 3 and 6 of therapy. Results: 87.5 and 83.9% of switched CD patients who were in remission at the time of the switch continued in remission, and 66.7 and 50% of naive CD patients reached remission, at months 3 and 6. In UC switched cases, 92 and 91.3% of patients in remission at the time of the switch continued in remission, at 3 and 6 months. In naive UC patients, the remission rates were 44.4 and 66.7%, at months 3 and 6. Adverse events occurred in 7.5% of patients during 6 months of study. Conclusions: CT-P13 was efficacious and well tolerated in patients with CD or UC.
Geospatial analysis of cutaneous malignant melanoma epidemiology in Europe From 2017 to 2021
(Wiley, 2025-05-14) Bueno‐Molina, Rocío C.; Sendín‐Martín, Mercedes; Hernández‐Rodríguez, Juan‐Carlos; Cayuela, Lucía; Cayuela, Aurelio; Pereyra-Rodríguez, José-Juan; Universidad de Sevilla. Departamento de Medicina
Background: Cutaneous melanoma is the most aggressive form of skin cancer. Although some studies have explored the epidemiology of melanoma in Europe, there is limited data on its spatial distribution. Materials and methods: A longitudinal ecological study was conducted to analyze melanoma incidence and mortality from 2017 to 2021 using data from the Global Burden of Disease database. Cases were identified using the International Classification of Diseases (ICD)-9 and ICD-10 codes for both sexes across four European geographical regions, excluding Russia. Age-standardized incidence and mortality rates were calculated. A distance-based spatial weights matrix was generated using GeoDa software to define neighborhood structure. Hotspot analysis of spatial clusters was conducted using the Getis-Ord Gi* statistic. Additionally, the mortality-to-incidence ratio was calculated. Results: Between 2017 and 2021, a total of 606,448 new melanoma cases were diagnosed in Europe. Both sexes exhibited higher incidence and mortality rates in Northern Europe. All rates were consistently lower in women. For both sexes, incidence hotspots were identified in Sweden, Denmark, the Netherlands, and the United Kingdom. In contrast, mortality hotspots are primarily observed in the Nordic countries, as well as in Eastern Europe. Incidence coldspots are predominantly found in southeastern Europe, whereas mortality coldspots are primarily concentrated in Spain and Portugal. The overall mortality-to-incidence ratio in Europe remained stable during the period, with an evident east-west gradient and higher mortality relative to incidence observed in Eastern Europe. Conclusion: This analysis reveals distinct geographical patterns, characterized by a north-south gradient in incidence and mortality. In contrast, the mortality-to-incidence ratio follows an east-west gradient, highlighting significant disparities in healthcare access.
Monitorización terapéutica de los fármacos biológicos en la enfermedad inflamatoria intestinal. Documento de Posicionamiento del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU)
(Elsevier, 2024-05) Rodríguez-Morantaa, Francisco; Argüelles Arias, Federico; Hinojosa del Val, Joaquín; Iborra Colomino, Marisa; Martín-Arranz, M. Dolores; Menchén Visog, Luis; Gutiérrez Casbas, Ana; Universidad de Sevilla. Departamento de Medicina
El tratamiento de la enfermedad inflamatoria intestinal (EII) ha sufrido una gran transformación tras la introducción de los fármacos biológicos. Gracias a ellos, los objetivos del tratamiento han evolucionado desde la respuesta y remisión clínica a objetivos más ambiciosos, como la remisión endoscópica o radiológica. Sin embargo, aunque los biológicos son muy eficaces, un porcentaje importante de pacientes no obtendrá una respuesta inicial o la perderá a lo largo del tiempo. Sabemos que existe una relación directa entre las concentraciones valle del biológico y su eficacia terapéutica, que cuanto más exigente sea el objetivo terapéutico serán necesarios niveles superiores del fármaco y que es frecuente la exposición insuficiente al mismo. La monitorización terapéutica de medicamentos biológicos, así como los modelos farmacocinéticos, nos brindan la posibilidad de ofrecer un enfoque personalizado del abordaje en pacientes con EII. Durante los últimos años se ha acumulado información relevante respecto a su utilidad durante o después de la inducción, así como en el mantenimiento del tratamiento biológico, en estrategias reactivas o proactivas y antes de la retirada o desintensificación del esquema. El objetivo de este documento es establecer recomendaciones sobre la utilidad de la monitorización terapéutica de biológicos en pacientes con EII, en los diferentes escenarios de la práctica clínica e identificar las áreas donde su utilidad es evidente, prometedora o controvertida.
Limitations of faecal calprotectin in detecting histological changes and persistent villous atrophy in patients with coeliac disease on a gluten-free diet
(Wiley, 2025) Segura, Verónica; Ruiz-Carnicer, Ángela; Pizarro, Ángeles; González-Naranjo, Carmen; Díaz, Jacobo; Coronel-Rodríguez, Cristóbal; Argüelles Arias, Federico; Comino, Isabel; Universidad de Sevilla. Departamento de Medicina; Junta de Andalucía
Faecal calprotectin is used to assess intestinal inflammation, but its role in monitoring mucosal healing in coeliac disease is unclear. This study followed 48 adults with coeliac disease on a gluten-free diet over 12 months, evaluating faecal calprotectin levels in correlation with anti-transglutaminase antibodies, gluten-free diet adherence by dietary questionnaires and histology. Although significant histological lesions (Marsh II–III) decreased from 24% to 10%, faecal calprotectin levels fluctuated without correlation to anti-transglutaminase, adherence or histological remission, and did not differentiate between lesion grades. Our findings underscore faecal calprotectin's unreliability in monitoring mucosal healing in adults with coeliac disease, highlighting the urgent need for alternative biomarkers
Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project
(Oxford University Press (OUP), 2020-12-06) Pezzani, Maria Diletta; Mazzaferri, Fulvia; Compri, Monica; Galia, Liliana; Mutters, Nico T.; Kahlmeter, Gunnar; Rodríguez-Baño, Jesús; Neth, Olaf; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; Unión Europea
Objectives: To systematically summarize the evidence on how to collect, analyse and report antimicrobial resistance (AMR) surveillance data to inform antimicrobial stewardship (AMS) teams providing guidance on empirical antibiotic treatment in health care settings. Methods: The research group identified 10 key questions about the link between AMR surveillance and AMS using a checklist of 9 elements for good practice in health research priority settings and a modified 3D combined approach matrix, and conducted a systematic review of published original studies and guidelines on the link between AMR surveillance and AMS. Results: The questions identified focused on AMS team composition; minimum infrastructure requirements for AMR surveillance; organisms, samples and susceptibility patterns to report; data stratification strategies; reporting frequency; resistance thre sholds to drive empirical therapy; surveillance in high-risk hospital units, long-term care, outpatient and veterinary settings; and surveillance data from other countries. Twenty guidelines and sevenoriginal studies on the implementation of AMR surveillance aspart of an AMS programme were included in the literature review. Conclusions: The evidence summarized in this review provides a useful basis for a more integrated process of developing procedures to report AMR surveillance data to drive AMS interventions. These procedures should be extended to settings outside the acute-care institutions, such as long-term care, outpatient and veterinary. Without proper AMR surveillance, implementation of AMS policies cannot contribute effectively to the fight against MDR pathogens and may even worsen the burden of adverse events from such interventions.
Influence of age, body mass index and comorbidity on major outcomes in acute pancreatitis, a prospective nation-wide multicentre study
(Sage, 2018-05) Moran, Robert A.; García-Rayado, Guillermo; Iglesia-García, Daniel de la; Martínez-Moneo, Emma; Fort-Martorell, Esther; Lauret-Braña, Eugenia; Argüelles Arias, Federico; Madaria, Enrique de; Universidad de Sevilla. Departamento de Medicina
Background There are few large prospective cohort studies evaluating predictors of outcomes in acute pancreatitis. Objectives The purpose of this study was to determine the role of age and co-morbid disease in predicting major outcomes in acute pancreatitis. Methods Data points were collected according to a predefined electronic data collection form. Acute pancreatitis and its complications were defined according to the revised Atlanta classification. Univariable and multivariable analyses were conducted using Cox proportional hazard regression and multiple logistic regression. Results From June 2013–February 2015, 1655 adult patients were recruited from 23 centres across Spain. Co-morbid disease, obesity, open surgical necrosectomy within 30 days, and pancreatic necrosis were independently associated with both 30-day mortality and persistent organ failure (p < 0.05 for all). Age was not associated with persistent organ failure, however the extreme of age (>85 years) was associated with mortality (p < 0.05). Co-morbid disease and obesity were not independently associated with a prolonged length of stay or other markers of morbidity on adjusted analysis (p > 0.05). Conclusion Comorbidity and obesity are important determinates of mortality and persistent organ failure in acute pancreatitis, but in the absence of organ failure they do not appear to independently contribute to morbidity. This has important implications for severity classification and predictive models of severity in acute pancreatitis.

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